A non-government entity
Wellcare Simple Value (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Simple Value (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Simple Value (HMO-POS) in 2025, please refer to our full plan details page.
Wellcare Simple Value (HMO-POS) is a HMO-POS plan offered by Centene Corporation available for enrollment in 2025 to people living in Select Counties in IL. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Wellcare Simple Value (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Simple Value (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Wellcare Simple Value (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $420.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2500.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for Wellcare Simple Value (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Wellcare Simple Value (HMO-POS) plan has a $420 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have no copay, while standard generic drugs have 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. Those who qualify for the low-income subsidy will have no copay for Part D drugs.
Additional Benefits
The Wellcare Simple Value (HMO-POS) plan provides coverage for a wide range of healthcare services. This includes inpatient hospital stays with a copay for the first eight days, and no copay thereafter, along with coverage for outpatient services, ambulance, emergency services, primary care, and preventive services. The plan also offers benefits for hearing, vision, and dental services, often with no copay or a low copay for some services. Additional benefits include coverage for home infusion, dialysis, and durable medical equipment with varying copays and coinsurance. The plan also covers skilled nursing facility stays, with no copay for most days. Some other services include coverage for OTC items and a meal benefit, while other services such as private duty nursing, and cardiac rehabilitation services are not covered.
Inpatient Hospital See details
Inpatient Hospital services, including Acute and Psychiatric, are covered with prior authorization. For days 1-8, there is a $275 copay, and days 9-90 have no copay. Additional days and non-Medicare-covered stays for both Acute and Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay of $0-$280, Observation Services with a copay of $140-$280, Ambulatory Surgical Center (ASC) Services with a copay of $175, Outpatient Substance Abuse Services with a copay of $40 for individual and group sessions, and Outpatient Blood Services with no copay. Prior authorization is required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Simple Value (HMO-POS) plan, but requires prior authorization. The copay for this benefit is $130.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $225 copay for both ground and air ambulance services. Transportation Services to a plan-approved health-related location has a $0 copay, with a limit of 24 one-way trips per year, and covers rideshare services, bus/subway, and medical transport, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered. Emergency Services and Worldwide Emergency Coverage have a $140 copay, and Urgently Needed Services has no copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Simple Value (HMO-POS) plan covers primary care physician services with no copay. Chiropractic Services have a $10 copay, while Occupational Therapy Services, Physician Specialist Services, and Physical Therapy and Speech-Language Pathology Services each have a $10 copay. Mental Health and Psychiatric Services have a $40 copay for individual and group sessions. Other Health Care Professional services have a copay between $0 and $10. Additional Telehealth benefits have a 20% coinsurance with a copay between $0 and $40. Opioid Treatment Program Services have a $10 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services that may have a copay. Kidney disease education services have a 20% coinsurance, while other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit have no copay.
Hearing Services See details
The Wellcare Simple Value (HMO-POS) plan covers hearing exams with a $10 copay, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum plan benefit coverage of $1500 per year, with no copay for Prescription Hearing Aids (all types), but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC Hearing Aids are not covered.
Vision Services See details
The Wellcare Simple Value (HMO-POS) plan covers vision services including eye exams and eyewear. Eye exams have a copay between $0 and $10, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, also have no copay with a combined maximum of $400 per year.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $10 copay, and other services such as oral exams, dental x-rays, and cleanings with no copay. Orthodontic Services are covered up to a maximum of $5000 per year. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Wellcare Simple Value (HMO-POS) plan and require prior authorization. The plan covers Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Simple Value (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Wellcare Simple Value (HMO-POS) plan covers Durable Medical Equipment (DME) with 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medicare-covered Medical Supplies are covered with 20% coinsurance, and Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and lab services are covered. Diagnostic procedures/tests have a copay between $0 and $50, lab services have no copay, and diagnostic radiological services have a copay up to $280. Therapeutic radiological services have a coinsurance of at least 20%, and outpatient X-ray services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Simple Value (HMO-POS) plan with a 20% coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellcare Simple Value (HMO-POS) plan. However, the plan does cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Simple Value (HMO-POS) plan. There is no copay for days 1-20 and days 41-100, but there is a $214 copay for days 21-40; there is no coinsurance.
Other Services See details
Other Services includes Over-the-Counter (OTC) Items and Meal Benefit, with OTC items covered with no copay, and Meal Benefit covered with no copay and a doctor referral required. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved